Aubert-Tulkens G, Hamoir M, Van den Eeckhaut J, Rodenstein D O
Unité d'Explorations Electrophysiologiques du Système Nerveux, Cliniques Universitaires St. Luc, Brussels, Belgium.
Arch Intern Med. 1989 Sep;149(9):2118-21.
Seven adult patients with a severe form of sleep apnea syndrome (mean apnea index, 47) underwent surgery for significant structural abnormalities at nose and/or throat level (septal deviation, turbinal hypertrophy, enlarged tonsils, long uvula, pharyngeal tumor). Although a subjective benefit was claimed by most patients, the polygraphic data showed no improvement or only a modest improvement in breathing pattern, oxyhemoglobin saturation, or general sleep architecture except in one patient. In this patient the evolution of the syndrome was recent (3 years) and surgical management of a parapharyngeal tumor resulted in a cure. We conclude that in adults with sleep apnea syndrome of long-standing, surgical correction of nasal or pharyngeal abnormalities should not be expected to normalize sleep and breathing. This contrasts with the known benefits achieved by the same type of surgery in children. Surgery might nevertheless be necessary in some adults to permit the application of other therapeutic means (ie, nasal continuous positive airway pressure).
7名患有严重形式睡眠呼吸暂停综合征（平均呼吸暂停指数为47）的成年患者因鼻和/或咽喉部存在明显结构异常（鼻中隔偏曲、鼻甲肥大、扁桃体肿大、悬雍垂过长、咽部肿瘤）而接受手术。尽管大多数患者声称有主观改善，但多导睡眠图数据显示，除1例患者外，呼吸模式、氧合血红蛋白饱和度或总体睡眠结构并无改善或仅有适度改善。在该例患者中，综合征病程较短（3年），对咽旁肿瘤的手术治疗使其治愈。我们得出结论，对于长期患有睡眠呼吸暂停综合征的成年人，不应期望通过手术矫正鼻或咽异常来使睡眠和呼吸恢复正常。这与已知的同一类型手术在儿童中取得的益处形成对比。然而，在一些成年人中，手术可能仍是必要的，以便能够应用其他治疗手段（即鼻持续气道正压通气）。
